Postnatal cytolomegalovirus infection not linked to impaired motor development

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Postnatal cytomegalovirus (pCMV) infection in preterm infants associated with higher gross motor scores at 16 months of life and earlier age of onset of independent walking (AOIW).

2. At 6 years of age, children with a history of pCMV infection had cognitive scores within normal limits for age, although with significantly lower verbal IQ scores compared to their non-infected counterparts.

Evidence Rating Level: 1 (Excellent)

Study Rundown: CMV is one of the most common viral infection in neonates, and may be transmitted to neonates by congenital, perinatal, or postnatal route. Postnatal transmission commonly occurs via breastfeeding in virally shedding mothers. Term infants generally remain asymptomatic, but preterm infants and VLBW infants may be at increased risk of symptomatic disease and sequelae, including sepsis like syndrome and sensorineural hearing loss. Despite knowledge of acute complications, there is limited data on long-term neurodevelopmental outcomes in children with pCMV. The objective of this study was to evaluate neurodevelopmental outcomes in preterm infants who test positive for CMV postnatally. Developmental outcomes were measured through multiple, validated developmental and intelligence evaluations. Among the infants studied, pCMV infection was not associated with adverse effects on neurodevelopment during the first 6 years of life. At 6 years of age, infected children had significantly lower verbal IQ scores than their non-infected counterparts, but their scores were still within normal limits. The authors note that this difference is less clear as it may also be explained by maternal education and ethnicity. Infected infants had significantly higher motor performance at 16 months' corrected age (CA) and had significantly earlier onset of walking. For providers, these data may help guide breastfeeding pasteurization and feeding policies at individual neonatal intensive care units.

Click to read the study in Pediatrics

Relevant Reading: Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review

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In-Depth [prospective cohort study]: This single–center, prospective, longitudinal study included all infants <32 weeks gestational age admitted to the neonatal intensive care unit (NICU) at Wilhemina Children's Hospital in Utrecht, the Netherlands, from April 2007 to December 2010. Infants lacking urine CMV studies at term equivalence age (TEA), severe cerebral abnormalities, chromosomal anomalies, death before TEA or lack of parental consent were excluded. Of 701 preterm infants, there were 462 eligible infants with known CMV at TEA, of which 411 had follow-up data. Of these infants, pCMV was diagnosed in 74. At 16 months, 49 (14%) of pCMV infants and 307 (86%) of pCMV infants were evaluated with Griffiths Mental Development Scales (GMDS) scores. Infants with pCMV had higher locomotor subscale scores than their non-infected counterparts (z-score=0.35 [SD=0.81] vs 0.02 [SD=0.98] in the control; p = 0.025). Between 24-30 months of age, there were no significant differences between Bayley Scales of Infant and Toddler Development, Third Edition (BSITD-III) and GMDS z-scores among pCMV-positive and pCMV-negative infants. Infants with pCMV had significantly earlier age of onset of initial walking (AOIW) compared to non-pCMV infants (14.7 months [SD=2.4] and 15.8 months [SD=3.1]; p = 0.026). At 6 years of age, 33 of 118 (28%) children with pCMV and 85 of 118 (72%) of non-pCMV children received Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III) scores: Children with history of pCMV had mean scores all the normal range, with pCMV children having lower scores in verbal IQ compared to non-pCMV children (96 [SD=17] vs 103 [SD=15] points; p = 0.046). There were no significant differences in Movement Assessment Battery for Children, Second Edition (MABC-II) scores and sensorineural hearing loss between groups.

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